Citation Nr: 9931098
Decision Date: 10/29/99 Archive Date: 11/04/99
DOCKET NO. 96-49 305 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Houston,
Texas
THE ISSUE
Entitlement to service connection for a heart condition.
REPRESENTATION
Appellant represented by: The American Legion
ATTORNEY FOR THE BOARD
L. McCain Parson, Associate Counsel
INTRODUCTION
The veteran had verified active duty with the Army from May
1949 to August 1952 and Coast Guard service from April 1956
to February 1973.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from an August 1996 rating decision by the
Department of Veterans Affairs (VA) Regional Office (RO) in
Houston, Texas. This issue was previously before the Board
in July 1999 and has returned following a Remand for
additional development. That development has been completed
and the matter is ready for adjudication.
By a September 1999 letter, the veteran withdrew his request
for a hearing at the RO before a hearing officer.
Effective March 1, 1999, the United States Court of Veterans
Appeals changed its name to the United States Court of
Appeals for Veterans Claims (hereinafter, "the Court").
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of this claim has been obtained by the RO, to
the extent possible.
2. Competent medical evidence has not been submitted to
establish a nexus between the heart condition and his
military service.
CONCLUSION OF LAW
The veteran's claim for entitlement to service connection for
a heart condition is not well-grounded. 38 U.S.C.A. §
5107(a) (West 1991).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
As a preliminary matter, the Board observes that there does
not appear to be other obtainable evidence not already of
record which would be pertinent to the claim for service
connection for a heart condition. Specifically, the National
Personnel Records Center (NPRC) in June 1996 forwarded
available service medical records to the RO. Relying on the
veteran's statements regarding dates and places of treatment
while on active duty, the RO requested clinical records from
Charleston VA Medical Center. The Charleston Navy Hospital
Outpatient Records Secretary reported in May 1997 that they
had no records of the veteran and that the records would be
located at the NPRC. A July 1997 response from the
Charleston VA Medical Center reflects no records for the
veteran. By a January 1999 Administrative Decision, the RO
made an official finding that the records were unavailable.
Based on the foregoing search efforts and findings, the Board
is satisfied that its duty has been met and that all
reasonable efforts to develop the record have been made.
Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); Jolley v.
Derwinski, 1 Vet. App. 37, 39-40 (1990); see also Counts v.
Brown, 6 Vet. App. 473, 477 (1994) (quoting Porter v. Brown,
5 Vet. App. 233, 237 (1993) ("VA [has] no duty to seek to
obtain that which [does] not exist")).
The veteran asserts that his aortic stenosis is related to
the murmur in-service and that service connection is
warranted. He contends that he was prescribed medication for
a heart condition while in-service.
Facts
The service medical records for the period of Army service
from May 1949 to August 1952 are limited and consist only of
an Office of the Surgeon General report of a combat wound to
the foot dated in 1950 and the August 1952 separation
examination. These records are silent as regards a heart
murmur or a heart condition.
Service medical records for the period of U.S. Coast Guard
service from April 1956 to March 1973 reflect that the heart
(thrust, size, rhythm, sounds) was characterized by "split
S" on the separation/retirement physical examination dated
in November 1972. The veteran retired in March 1973.
The post service medical evidence consists of medical records
from the Brooke Army Medical Center for the period of
February 1991 to May 1997. In pertinent part, evaluations in
October 1992 reflect that the veteran was tachycardic with
S1/S2, no S4, no murmur, and 3+ edema extending to the knees.
The diagnoses included inter alia pulmonary hypertension. A
subsequent October 1992 entry reflects grade II systolic
murmur at base and loud S4. Thereafter, records reflect
systolic ejection murmur. Aortic stenosis was diagnosed in
December 1994 when the veteran was being "worked up for a
murmur during [an] evaluation for an umbilical hernia
repair." At that time, the veteran reported dyspnea of 3-4
months duration. A March 1995 entry reflects severe aortic
stenosis currently asymptomatic. In brief, medical records
dated in December 1995 and January 1996 reflect severe aortic
stenosis, hypertension, left ventricular hypertrophy,
diabetes mellitus, no evidence of significant coronary artery
disease, mild pulmonary hypertension, mitral annular
calcification without mitral stenosis, and aortic valve
replacement. These records bear no opinion as to etiology or
nexus to service.
Law and Regulations
In general, service connection may be granted for disability
due to disease or injury incurred in or aggravated by
service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. §
3.303(a) (1999).
Generally, a well-grounded claim for service connection
requires (1) medical evidence of a current disability; (2)
medical or, in certain circumstances, lay evidence of in-
service incurrence or aggravation of a disease or injury; and
(3) medical evidence of a nexus between the claimed in-
service disease or injury and the present disease or injury.
See Caluza v. Brown, 7 Vet. App. 489, 504, 506 (1995); see
also Epps v. Gober 126 F.3d 1464, 1468 (Fed. Cir. 1997)
(expressly adopting definition of well-grounded claim set
forth in Caluza, supra). The second and third Caluza
elements can be satisfied under 38 C.F.R. 3.303(b) by (a)
evidence that the condition was "noted" during service or
during an applicable presumptive period; (b) evidence showing
post-service continuity of symptomatology; and (c) medical
or, in certain circumstances, lay evidence of a nexus between
the present disability and the post-service symptomatology.
38 C.F.R. 3.303(b); Savage v. Gober, 10 Vet. App. 488, 495-97
(1997). For the purpose of determining whether a claim is
well-grounded, the credibility of the evidence in support of
the claim must be presumed. See Robinette v. Brown, 8 Vet.
App. 69, 75 (1995).
The Board notes that 38 C.F.R. §§ 3.307, 3.309 (1999)
establishes a one-year presumptive period for cardiovascular
disease. This means that the cardiovascular disease must
have become manifest to a compensable degree (10 percent or
more) within one year from the date of separation from
service. This is not interpreted as requiring that the
disease be diagnosed within the presumptive period, per se,
but only that there can be shown by acceptable medical or lay
evidence of characteristic manifestations of the disease to
the required degree, followed by a definite diagnosis within
a reasonable time. 38 C.F.R. § 3.307(c); Harvey v. Principi,
3 Vet. App. 343, 344-345 (1992).
Analysis
The Board acknowledges the veterans' contentions as to
receiving medical treatment for a heart condition while in-
service. However, there is no competent medical evidence
that establishes that the current disability manifest by
aortic stenosis is related to service. There are no medical
records reflecting evaluation or treatment of a heart
condition. Where the determinative issue involves medical
causation or a medical diagnosis, competent medical evidence
to the effect that the claim is plausible or possible is
required. See Grottveit v. Brown, 5 Vet. App. 91, 92 (1993).
The evidence of record reflects that the veteran separated
from service in 1973, however, the first post service medical
evidence of a diagnosed heart condition was in October 1992,
pulmonary hypertension, and thereafter in December 1994 a
diagnosis of aortic stenosis. The records pertinent to the
diagnosis and surgical treatment for aortic stenosis lack a
medical opinion which establishes that the current heart
condition is related to the veteran's military service.
Without a current disability related to his period of
service, the veteran has not presented a plausible claim.
See Epps and Grottveit, both supra.
If the veteran fails to submit evidence in support of a
plausible claim, the VA is under no duty to assist the
veteran in any further development of the claim. Further,
the veteran's burden to submit evidence sufficient to
establish a well-grounded claim is the veteran's alone and is
not relieved by the benefit of the doubt provision. 38
U.S.C.A. § 5107; Epps v. Gober, 126 F.3d 1464 (Fed. Cir.
1997).
The Board further finds that the RO advised the veteran of
the evidence necessary to establish a well-grounded claim,
and the veteran has not indicated the existence of any other
post service medical or other evidence that has not already
been requested and/or obtained that would well-ground his
claim. See McKnight v. Gober, 131 F.3d 1483 (Fed. Cir.
1997); Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). As the
foregoing discussion explains the need for competent medical
evidence that tends to establish a nexus between the current
heart condition and the veteran's military service, the Board
views its discussion as sufficient to inform the veteran of
the elements necessary to complete his application for
service connection for a heart condition. See Graves v.
Brown, 8 Vet. App. 522, 524 (1996); Robinette v. Brown, 8
Vet. App. 69, 77-78 (1995).
ORDER
Entitlement to service connection for a heart condition is
denied.
Deborah W. Singleton
Member, Board of Veterans' Appeals